Discuss Dentistry

Daily forum for dentists

The Process Behind Altering Vertical Dimension

Home › Forums › Prosthetic dentistry › Prosthetic dentistry › The Process Behind Altering Vertical Dimension › The Process Behind Altering Vertical Dimension

21/12/2012 at 5:12 pm #16265
Anonymous


Figure 1  The proposed gingival alteration marked on the cast.

Figure 1

Figure 2  Laboratory alteration of the gingival contours in the diagnostic wax-up.

Figure 2

Figure 3  Preoperative view. Note the worn incisal edges and end-on-end occlusal relationship requiring an increase in OVD to restore.

Figure 3

Figure 4  Interocclusal registration made at the approximate OVD for rehabilitation.

Figure 4

Figure 5  Accurate casts mounted at arbitrary OVD.

Figure 5

Figure 6  Incisal edge and lingual contour added to the maxillary anteriors.

Figure 6

Figure 7  Length added to the incisal edge of mandibular anteriors and contoured to the proper occlusal plane.

Figure 7

Figure 8  The articulator is closed and the tooth coupling evaluated. If the teeth touch and the incisal pin is on the table, the vertical relationship is ideal.

Figure 8

Figure 9: The incisal pin is down and the teeth do not occlude. Clinicians may choose to lower the pin and accept a more reduced OVD if the posterior teeth can be restored.

Figure 9

Figure 10  The laboratory may choose to add more contour to the lingual surface of the maxillary anteriors.

Figure 10

Figure 11  Combination of addition of maxillary lingual contour and mandibular incisal length.

Figure 11

Figure 12  Buccal cusps of posterior teeth should be a smooth continuation of the anterior teeth.

Figure 12

Figure 13  Initial matrix for mandibular rehabilitation. Anterior teeth may be provisionalized using the occlusal surfaces of the posterior teeth as stops.

Figure 13

Figure 14  After matrix removal. Anteriors are provisionalized with no flash on posteriors.

Figure 14

Figure 15  Posterior teeth are prepared and provisionalized. Anteriors are used as an occlusal stop.

Figure 15

Figure 16  Bis-acryl provisional matrix. Deep notches are cut in the matrix for resin escape. Also note the notch in the midline for positioning.

Figure 16

Figure 17  Temphase escapes the matrix to the buccal, aiding in complete seating.

Figure 17

Figure 18  Minimal resin on palate demonstrates ideal matrix seating.

Figure 18

Figure 19  The Temphase tip is placed deep in the matrix and flow is directed around the arch to prevent bubbles in the embrasures and cusp tips.

Figure 19

Figure 20  The reduction matrix.

Figure 20

Figure 21  Occlusal view of the reduction matrix.

Figure 21

Figure 22  Facial and incisal reduction on the matrix.

Figure 22

Figure 23  Lingual reduction.

Figure 23

Figure 24  Bur marks demonstrate where reduction must occur as well as the depth.

Figure 24

Figure 25  The provisional is segmented based on how the case is to be impressed and how the interocclusal record is to be fabricated.

Figure 25

Figure 26  Anterior provisionals are removed and the patient closes into bite registration. The posterior teeth are adjusted to centric relation.

Figure 26

Figure 27  The anterior registration is trimmed to demonstrate proper seating.

Figure 27

Figure 28  Addition of bite registration material posteriorly. The patient is instructed to bite into the anterior matrix half-hard to prevent distalization or overseating of the condyle.

Figure 28

Figure 29  Accurate interocclusal registration demonstrating no overlap of material between the three segments.

Figure 29

Figure 30  Final restorations.

Figure 30

Figure 31  Technical precision and artistic skill blend into a pleasing smile and a happy patient.

Figure 31